Push or pull? : The relationship between quality of care and use of complementary and alternative medicine among patients with lung cancer in Sweden

Little is known about relationships between quality of care (QoC) and use of complementary and alternative medicine (CAM) among patients with lung cancer (LC). Purpose: This study examines CAM-use among patients with LC in Sweden, associations between QoC and CAM-use among these patients, and reported aspects of LC-care perceived as particularly positive and negative by patients, as well as suggestions for improving QoC. Methods: Survey data from 94 patient members of the Swedish LC patient organization about CAM-use and QoC as measured by the instrument “Quality from the patient’s perspective” were analyzed. Results: Fifty (53%) LC-patients used CAM, with 40 of the CAM-users reporting that CAM helped them. The most common CAMs used were dietary supplements and natural remedies, followed by prayer. Significantly more patients reported using prayer and meditation for cure than was the case for other types of CAM used. Less than half the CAM-users reported having spoken with staff from the biomedical health care system about their CAM-use. Patients provided numerous suggestions for improving LC-care in a variety of areas, aiming at a more effective and cohesive care trajectory. No differences in QoC were found between CAM-users and non-CAM-users, but differences in CAM-use i.e. type of CAM, reasons for using CAM, and CAM-provider consulted could be associated with different experiences of care. Conclusions: It is important to recognize that CAM-users are not a homogeneous group but might seek different types of CAMs and CAM-providers in different situations depending on experiences of care.

Mångfald - Från ord till handling : En kvalitativ studie om HRs strategiska arbete med mångfald

Denna studie grundar sig i ett uppdrag från Trafikverket med avsikten att undersöka hur enmångfaldsstrategi kan få ökad effekt i organisationen. Utgångspunkten för denna studie är attdet tycks krävas mer forskning kring hur HR strategiskt kan arbeta med mångfaldsfrågor ochintegrera dem i organisationens alla delar. Syftet med denna studie är således att identifiera hurHR strategiskt kan arbeta med mångfaldsfrågor. Vidare är syftet att visa hur ett strategiskamångfaldsarbete kan bli mer effektivt.Teorier som belyser begreppet mångfald, effekterna av mångfald, strategi, Human ResourceManagement och Strategic Human Resource management kan ses ligga till grund för ettframgångsrikt HRM-arbete med mångfald. Ledarskap, kommunikation, kunskap och att se tillorganisationskulturen belyser teorin som viktiga komponenter för att ett strategiskt arbete skabli mer effektivt och ge effekt i organisationen.Studien bygger på en deduktiv ansats och en kvalitativ metod har genomförts utifrån treindividuella intervjuer och två fokusgrupper. De individuella intervjuernas syfte var att belysaorganisationens nutida arbete med mångfald, framtida perspektiv för hur ett strategisktmångfaldsarbete kan utformas och en målbild för vad arbetet ska resultera i. Den enafokusgruppen bestod av medarbetare från HR från olika regionkontor i landet och hade somsyfte att klargöra hur HR strategiskt kan arbeta med mångfald. Den andra fokusgruppen bestodav chefer från olika regionkontor i landet och hade som syfte att belysa chefers roll och vad deeftersöker i ett strategiskt mångfaldsarbete.Resultatet från intervjuerna har analyserats utifrån den teoretiska referensramen och i dennastudie har vi kommit fram till och identifierat flera betydelsefulla faktorer som för HR är viktigai utformandet av en mångfaldsstrategi. Det är viktigt att definiera begreppet mångfald, klargöraansvarsfrågan, visa på varför organisationen bör arbeta med månglad och kommuniceraeffekterna. Vidare är det viktigt att koppla mångfaldsstrategin till övriga HRM-aktiviteter ochorganisationens övriga strategier och mål för att det strategiska arbetet ska ge effekt. Kunskapom mångfald och att se arbetet som ett förändringsarbete där ledningen utgör en viktig roll harvisat sig vara väsentliga faktorer för att arbetet ska få värde i organisationen.

Dialekter och röstigenkänning : Ett röstigenkännings-API:s förmåga att uppfatta svenska dialekters kännetecken och röstkombinationer

Allt eftersom utvecklingen går framåt inom applikationer och system så förändras också sättet på vilket vi interagerar med systemet på. Hittills har navigering och användning av applikationer och system mestadels skett med händerna och då genom mus och tangentbord. På senare tid så har navigering via touch-skärmar och rösten blivit allt mer vanligt. Då man ska styra en applikation med hjälp av rösten är det viktigt att vem som helst kan styra applikationen, oavsett vilken dialekt man har. För att kunna se hur korrekt ett röstigenkännings-API (Application Programming Interface) uppfattar svenska dialekter så initierades denna studie med dokumentstudier om dialekters kännetecken och ljudkombinationer. Dessa kännetecken och ljudkombinationer låg till grund för de ord vi valt ut till att testa API:et med. Varje dialekt fick alltså ett ord uppbyggt för att vara extra svårt för API:et att uppfatta när det uttalades av just den aktuella dialekten. Därefter utvecklades en prototyp, närmare bestämt en android-applikation som fungerade som ett verktyg i datainsamlingen. Då arbetet innehåller en prototyp och en undersökning så valdes Design and Creation Research som forskningsstrategi med datainsamlingsmetoderna dokumentstudier och observationer för att få önskat resultat. Data samlades in via observationer med prototypen som hjälpmedel och med hjälp av dokumentstudier. Det empiriska data som registrerats via observationerna och med hjälp av applikationen påvisade att vissa dialekter var lättare för API:et att uppfatta korrekt. I vissa fall var resultaten väntade då vissa ord uppbyggda av ljudkombinationer i enlighet med teorin skulle uttalas väldigt speciellt av en viss dialekt. Ibland blev det väldigt låga resultat på just dessa ord men i andra fall förvånansvärt höga. Slutsatsen vi drog av detta var att de ord vi valt ut med en baktanke om att de skulle få låga resultat för den speciella dialekten endast visade sig stämma vid två tillfällen. Det var istället det ord innehållande sje- och tje-ljud som enligt teorin var gemensamma kännetecken för alla dialekter som fick lägst resultat överlag.

Materialising bodies : there is nothing more material than a socially constructed body.

Over the last one of two decades, researchers within the physical education (PE) and sport pedagogy research frequently use the concept ‘the material body’. An initial purpose of this article is to explore what a concept of a ‘material body’ might mean. What other bodies are there? Who would dispute the materiality of bodies? I suggest that the use of a concept as ‘the material body’ suggests a hesitation before the radicalism of the linguistic turn in the sense that the concept ‘discourse’ does not include a material dimension. In this way ‘the material body’ relates to an interpretation of ‘the socially (or discursively) constructed body’ as void of matter. A further purpose with the article is to re-inscribe matter in the concept of ‘discourse’. This is done by way of discussing what theorists like Michel Foucault and, in particular, Judith Butler, has to say about the materiality of the body. In their writings, discourse should not be limited to spoken and/or written language. Rather, discourse is understood in terms of actions and events that create meanings—that matters. One conclusion of the article is that it is important to problematise the mundane view of discourse as ‘verbal interchange’ because it reinforces the promise of an objective knowledge that will eventually shed light on the ‘real’ body and the mysteries of sexual difference, what its origins are, what causes it. Another conclusion is that the PE and sport pedagogy research should pay less attention to the body as an object (what it ‘is’), and pay more attention to how the body matters, and e.g. how movements make bodies matter.

Formal caregivers' perceptions of quality of care for older people : associating factors

Background: Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers' perspective. The aim was to describe formal caregivers' perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient's Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431). Results: In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience. Conculsions: The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers' working conditions are of great importance for quality of care.

Mellan etnologi och modern sociologi : K. Rob. V. Wikman som medlare i Finland och Sverige

Between ethnology and sociology: K. Rob. V. Wikman as a mediator in Finland and Sweden K. Rob. V. Wikman, professor in sociology at the Åbo Akademi University in Turku, Finland, played a central role both within Finnish and Swedish sociology in the 1940s and 1950s. He was a student of Westermarck and thus his own research represented an ethnosociological tradition, which at that time was challenged by modern, American-influenced sociological ideas. The aim of this article is to discuss the adaptation of “modern sociology” and the drawing of boundaries in Nordic sociology after the Second World War by focusing on Wikman’s work in Finnish as well as Swedish sociology, especially the assessor assignments he was given, and by giving emphasis to some of those that served as border poles or border markers in this process. The comparative starting point gives us reason to discuss some nationally characterized similarities and differences that can be observed in the establishment process of modern sociology in Finland and Sweden.

Revisorn och den institutionaliserade misstron : professionaliseringen av svensk bolagsrevision

The auditor and the insitutionalization of distrust: the professionalization of external auditing in Sweden This paper addresses professionalization with a focus on trust, rather than on issues of power and competition. It contains a conceptual analysis of trust/confidence, as well as a case study of the professionalization of external auditing in Sweden. The conceptual analysis discusses the “time-binding” aspect of trust/confidence, and the significance of social control mechanisms related to “persons”, “roles”, “values” and “programs” for creating and sustaining trust/confidence. The case study focuses on the role of trust/confidence for the organization and professionalization of external auditing in Sweden, and in particular on the ways in which trust in auditors and auditing have been stabilized. The latter issue is dealt with through a discussion attempting to capture a historic displacement in three dimensions: from reliance on the auditor’spersonal reliability, to trust in the professional role; from trust in the individual discretion of certain persons to trust in the regulation of auditing as a standardized program; and finally, from trust in the values represented by individual auditors to trust in the institutionalized professional values.

The Graphic Designer as (a)Digital Nomad : A qualitative study

Syftet med denna studie var att undersöka hur digitala nomader utövar sitt yrke som grafiska designers, varför de valde att bli digitala nomader samt vilka fördelar och nackdelar som finns. Totalt intervjuades 10 före detta och nuvarande digitala nomader via email och svaren sammanställdes och analyserades för att finna teman och sammanhang. Resultatet visar att deltagarna valde en digital nomadisk livsstil främst på grund av den frihet det innebär. De är även helt beroende av internet, då det är den grundläggande teknologin som möjliggör distansarbete. Att vara digital nomad verkar inte ha en negativ inverkan på den grafiska designprocessen och alla verktyg som behövs anser de finns tillgängliga digitalt. Den del av det traditionella designyrket på en byrå som deltagarna i studien saknade mest var kreativa diskussioner med kollegor.

Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

Large-scale metabolomic profiling identifies novel biomarkers for incident coronary heart disease

Analyses of circulating metabolites in large prospective epidemiological studies could lead to improved prediction and better biological understanding of coronary heart disease (CHD). We performed a mass spectrometry-based non-targeted metabolomics study for association with incident CHD events in 1,028 individuals (131 events; 10 y. median follow-up) with validation in 1,670 individuals (282 events; 3.9 y. median follow-up). Four metabolites were replicated and independent of main cardiovascular risk factors [lysophosphatidylcholine 18∶1 (hazard ratio [HR] per standard deviation [SD] increment = 0.77, P-value<0.001), lysophosphatidylcholine 18∶2 (HR = 0.81, P-value<0.001), monoglyceride 18∶2 (MG 18∶2; HR = 1.18, P-value = 0.011) and sphingomyelin 28∶1 (HR = 0.85, P-value = 0.015)]. Together they contributed to moderate improvements in discrimination and re-classification in addition to traditional risk factors (C-statistic: 0.76 vs. 0.75; NRI: 9.2%). MG 18∶2 was associated with CHD independently of triglycerides. Lysophosphatidylcholines were negatively associated with body mass index, C-reactive protein and with less evidence of subclinical cardiovascular disease in additional 970 participants; a reverse pattern was observed for MG 18∶2. MG 18∶2 showed an enrichment (P-value = 0.002) of significant associations with CHD-associated SNPs (P-value = 1.2×10-7 for association with rs964184 in the ZNF259/APOA5 region) and a weak, but positive causal effect (odds ratio = 1.05 per SD increment in MG 18∶2, P-value = 0.05) on CHD, as suggested by Mendelian randomization analysis. In conclusion, we identified four lipid-related metabolites with evidence for clinical utility, as well as a causal role in CHD development.

The Nurse Professional Competence (NPC) scale : self-reported competence among nursing students on the point of graduation

BACKGROUND: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. OBJECTIVES: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. METHODS AND PARTICIPANTS: The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1 [20-56]years, 87.3% women) from 11 universities/university colleges participated. RESULTS: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (93.2% vs 87.5% of NSPGs). SUMMARY AND CONCLUSION: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.

Arbetsglädje och meningsfullhet ur ett lärarperspektiv

Lärares arbetssituation är ett aktuellt tema, både i media och bland myndigheter diskuteras det mycket om läraryrket. Syftet med studien är att ta reda på vad arbetsglädje är för lärare, vilka faktorer som påverkar arbetsglädjen och om lärare upplever sitt arbete som meningsfullt. Därför har en kvalitativ studie genomförts där ett antal lärare i grundskolan har intervjuats. Studien har riktat sig till lärare med yrkeserfarenhet på mellan 5 och15 år. Resultatet visar att arbetsglädje för lärare är mötet med eleverna och när lärarna får ta del av elevernas spännande idéer och utveckling. Det framgår också av resultatet att faktorer som alltför många arbetsuppgifter och tidsbrist, påverkar arbetsglädjen för lärare. Resultatet visar att lärare upplever sitt yrke som klart meningsfullt. Dilemmat är att läraryrket är komplext, det innebär mycket ansvar och har många olika faktorer att ta hänsyn till. Framförallt begränsar tid och resurser arbetet.